The ketogenic diet, famed for its fat-burning potential, is showing promising results in treating anorexia nervosa. Recent research indicates that three out of four participants with eating disorders fell below diagnostic criteria while on a diet rich in fats, moderate in protein, and very low in carbohydrates. This dietary shift is believed to restore energy release in brain cells disrupted by anorexia, thus alleviating anxiety and the compulsion to restrict food intake.

This method mimics a state of starvation through carbohydrate restriction, which can lead to severe health risks. Studies show that anorexia is one of the mental health conditions with the highest mortality rates. However, Guido Frank, a researcher at UC San Diego, emphasizes that with proper supervision, the destructive urge to self-starve can potentially be mitigated. “Clinicians describe it as akin to an addiction. If we could stimulate a craving for food while ensuring adequate intake, it may be advantageous,” he explains.

Frank and his team conducted a 14-week study with 22 women suffering from anorexia whose body mass index (BMI) had improved to a range between healthy weight and slightly underweight. Under the guidance of a nutritionist, psychiatrist, and a peer support counselor experienced in anorexia treatment, these women followed a ketogenic diet. Their weight, mood, and anorexia symptoms were closely monitored each week, with surveys assessing changes in body image, depression, and food-related anxieties.

The results were significant: 18 women adhered to the ketogenic diet for the full 14 weeks, reporting considerable improvements in their anorexia symptoms and depression scores. Remarkably, 13 of these women (72%) fell below the clinical diagnostic thresholds for both conditions. According to Frank, “The recovery levels were far superior compared to other treatments for anorexia.”

Although the primary focus of the study was not weight gain, all participants maintained values within a slightly underweight but healthy BMI range and did not experience relapses.

The ketogenic diet derives its name from the metabolic adaptations it promotes to help the body endure periods of famine. Typically, our metabolism is carbohydrate-driven, converting these sugars into glucose, which is then utilized in the mitochondria for energy.

In the absence of carbohydrates, the body shifts to burn fat, releasing stored fat and converting it into ketone bodies in the liver. These ketone bodies serve as an alternative energy source in the mitochondria instead of glucose.

Initially developed in the 1920s for epilepsy treatment—not weight loss—the ketogenic diet mirrors starvation while providing sufficient dietary fats to prevent significant weight loss. This diet aims to replicate the fasting state, known for reducing seizure activity, offering a more sustainable treatment option.

Recent studies have revealed a correlation between various mental health issues, such as epilepsy and anorexia, and dysfunctions in glucose energy release in the brain. Ketone bodies may alleviate this dysfunction by supplying a different energy source.

Dr. Sahib Khalsa, a professor at UCLA specializing in eating disorder research and treatment, cautions those considering the ketogenic approach for anorexia. “It’s vital to differentiate between supervised treatment by a professional team and attempting this on your own. Until larger randomized controlled trials are conducted, it risks premature changes in anorexia management protocols, which typically include therapy and nutritional support,” she notes.